Deans' stroke musings
Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that each day because there are effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html
Tuesday, January 24, 2017
Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
Worthless, nothing on using antidepressants to help recovery. Are they(ASA) that incompetent that no one reads any research at all? 4 years ago and no fucking knowledge of this?
Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice.
Depression occurs in approximately one third of stroke survivors at any one time1 and is associated with poor functional outcomes2 and higher mortality.3 Although poststroke depression (PSD) is one of the most common complications after stroke, few guidelines exist regarding assessment, treatment, and prevention of PSD. This scientific statement summarizes published evidence on the causes, predisposing factors, epidemiology, screening, treatment, and prevention of PSD; illuminates gaps in the literature; and provides management implications for clinical practice.
Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Multiple disciplines were represented, including neurology, psychiatry, psychology, neurorehabilitation, primary care, epidemiology, biostatistics, and nursing. The writing group met by telephone to determine subcategories to evaluate. These included 9 sections that covered the following: incidence, prevalence, and natural history; pathophysiology; predictors; functional outcomes; quality of life (QOL); healthcare use; mortality; screening; and management and prevention. Each subcategory was led by a primary author, with 1 to 3 additional coauthors. Full searches of PubMed, Ovid MEDLINE, Ovid Cochrane Database of Systematic Reviews, Ovid Central Register of Controlled Trials databases, Internet Stroke Center/Clinical Trials Registry (http://www.strokecenter.org/trials/), and National Guideline Clearinghouse (http://guideline.gov/) were conducted of all English-language articles on human subjects, published through February of 2015. The evidence was organized within the context of the American Heart Association Framework. Drafts of summaries and suggestions/considerations for clinical practice were circulated to the entire writing group for feedback. Sections were revised and merged by the Chair. The resulting draft was reviewed and edited by the Vice-Chair, and the entire committee was asked to approve the final draft. Changes to the document were made by the Chair and Vice-Chair in response to peer review, and the document was again sent to the entire writing group for suggested changes and approval. A summary of findings is available in the Table.
Depression is common after stroke, affecting approximately one third of stroke survivors at any one time after stroke (compared with 5%–13% of adults without stroke), with a cumulative incidence of 55%.4–6 Hackett et al performed a systematic review and meta-analysis of 51 studies conducted before June 2004 and revealed a pooled frequency estimate of PSD of 33% (95% confidence interval [CI], 29%–36%).7 All studies included ischemic stroke, most included intracerebral hemorrhage, and the majority excluded subarachnoid hemorrhage and transient ischemic attack. Valid methods were used to ascertain depression in these studies. The primary end point was the proportion of patients who met the diagnostic category of depression, which included the following: (1) depressive disorder, depressive symptoms, or psychological distress, as defined by scores above a cut point for abnormality on a standard scale; (2) major depression, or minor depression (or dysthymia) according to the third, fourth, and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders, or other standard diagnostic criteria using structured or semistructured psychiatric interviews. Ayerbe et al’s subsequent systematic review and meta-analysis of 43 cohorts published before August 2011 (n=20 293) revealed a similar pooled frequency of PSD of 29% (95% CI, 25%–32%).8 The frequency remained fairly constant for the first year after stroke and diminished slightly thereafter (28%; 95% CI, 23%–34% within 1 month of stroke; 31%; 95% CI, 24%–39% at 1–6 months; 33%; 95% CI, 23%–43% at 6 months to 1 year; and 25%; 95% CI, 19%–32% beyond 1 year). Only 5 studies in Ayerbe et al’s systematic review reported other measures of natural history of PSD: incidence in year 1 ranged from 10% to 15% (2 studies); cumulative incidence ranged from 39% to 52% (3 studies with follow-up periods between 1 and 5 years); and 15% to 50% of patients with PSD within 3 months of stroke recovered 1 year later. All longitudinal studies revealed a dynamic natural history, with new cases and recovery of depression occurring over time.8 Little is known about whether the natural course of PSD differs in those with a history of depression before stroke.
Hackett et al updated their systematic review and meta-analysis in 20141 to include all published observational studies with prospective consecutive recruitment of stroke patients and assessment of depression or depressive symptoms at prespecified time points (until May of 2013; 61 studies; n=25 488; 29 cohorts were also in Ayerbe et al’s review). Their study revealed similar results, with depression present in 33% (95% CI, 26%–39%) at 1 year after stroke, with a decline beyond 1 year: 25% (95% CI, 16%–33%) up to 5 years, and 23% (95% CI, 14%–31%) at 5 years.1 Prevalence of PSD was lower beyond 1 year: Subgroup analyses revealed a pooled prevalence estimate of 31% (95% CI, 27%–35%) for the 48 studies (n=23 654) including individuals with a history of depression; 34% (95% CI, 29%–39%) for the 25 studies (n=19 218) including individuals with aphasia; and 33% (95% CI, 28%–38%) for the 25 studies (n=5658) of people with first-ever stroke.1
In Hackett’s and Ayerbe’s meta-analyses, the prevalence rates did not differ significantly over time during the first year after stroke (within 1 month from stroke, 1–6 months, or 6–12 months) or by setting (hospital, rehabilitation, or population based). The studies included in Hackett’s and Ayerbe’s reviews were heterogeneous in nature, using a variety of methods to diagnose depression and different thresholds for the same scale. The hospital- and rehabilitation-based studies had numerous exclusion criteria (such as excluding those with a history of depression), thus limiting their generalizability. Statistical quality and presentation of methods and results were poor in many studies, and important covariates (such as history of depression) were not included in multivariable models in most studies. Few of the multivariable models were likely to be stable as the ratio of events per variable in the model met or surpassed the recommended minimum.
In summary, approximately one third develop PSD at some point after stroke. The frequency is highest in the first year, at nearly 1 in 3 stroke survivors, and declines thereafter.
More at link.